2021 MEMBER GUIDE GET THE MOST OUT OF YOUR PLAN - BLUECROSS BLUESHIELD OF TENNESSEE
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021 Member Guide GET THE MOST OUT OF YOUR PLAN
Welcome to BlueCross We’re glad you’re part of our BlueCross BlueShield of Tennessee community and we’re ready to show you around your insurance plan. If this is your first time having insurance – or even if you’ve been covered by other plans before – you may have questions about how your new plan works. We’ve covered the basics in this book. If you ever need help or more detailed information, we’re right here for you.
We’re Here to Help
Your Member Care Team is happy to support your care goals and answer questions as you get
started with your new plan. If you need help using your benefits, getting care or understanding
how things work, we’re right here.
Get in touch with us the way that
works best for you.
Online: bcbst.com/Bridgestone
Manage your account from your
PC, smartphone or tablet 24/7
Phone: 1-800-250-7331
TTY: 1-800-848-0298
24 hours a day/
7 days a week*
We offer help in 150 different languages.
¿Tienes Preguntas? Tenemos las Respuestas. Tenemos representantes de servicio al
cliente que hablan español y pueden ayudarle con sus preguntas. Para hablar con un
representante de servicio al cliente, marque el número 1-866-636-0164. Presione “1”
para preguntas sobre su seguro médico o “2” para su seguro dental.
If you’d like help in a language other than English, just call 1-800-250-7331.
*Excludes holidays
1
Let’s Get Started
If you have a new health plan, you may be wondering what you need
to do first. We can help with that. The next page shows you how to
get started using your plan the easy way.
2
Your First Stop on Our Site
There’s a lot to see and do on our member site, and we want you to explore all the tools
and information when you have time. But there are a couple of things we hope you’ll do
on your first visit.
STEP 1
Activate your online account
When you’re on
Visit us online at bcbst.com/Bridgestone to the go – we’re still
activate your account. It’s fast and easy, and once
right here.
you’re registered, you’ll have 24/7 access to your
account information and tools that make keeping Our member site is mobile
up with your health care more convenient. friendly so you can use it on
your smartphone or tablet,
You can see what care is covered, check your no matter where you are.
balances and claims status, and find out where
you can go to get care when you need it.
STEP 2
Decide if you want to go paperless
You can reduce the amount of mail we send you
by choosing “go paperless.” Just go to Account
and then choose Communication Settings. You’ll
still receive some documents by mail, but you’ll
get emails anytime they’re available.
STEP 3
Tell us if you have any other insurance
(even if you don’t)
We need this information so we can pay your
claims correctly and on time. We need to hear
from you, even if you don’t have other insurance.
We’ll check in with you about any new insurance
around the same time every year.
3
Before You Get Care
Using your insurance is as simple as showing your Member ID card
when you go to the doctor or hospital. But knowing a few things up
front can help you save money and get the most out of your benefits.
4
Staying in Your Network
Saves You Money
We work with certain doctors, hospitals and specialists to
give you the best member discounts for care. We call this
your provider network. When you choose to get care inside
that network, you save money. Before you get care, ask your
provider if they’re in your network. Or, check for yourself
using the Find a Doctor tool. You can find it under
Find Care & Estimate Costs when you log in to your
bcbst.com account.
Screenings
Keep You Healthy
Keeping an eye on your health – even when you’re feeling fine –
could save you money in the long run. When health problems are
found early (before they become more serious), they’re often easier and
less costly to treat.
Most plans cover yearly checkups with an in-network doctor at no
cost. This checkup may also include lab tests to check for common health problems and
immunizations.
Some Services May Need Approval
Before you get care, it’s a good idea to make sure your plan covers it. You can find out by
visiting the Benefits & Coverage section of your member site. If something needs approval,
your doctor will need to check with us before you get the care so you don’t have to pay
unexpected costs. Here are some things that might need approval:
• Surgeries • MRIs, CT scans or PET scans
• Stays in the hospital • Renting or buying medical equipment
5
Planning to Get Care
Using a provider in your network is a good start when you’re planning
to get care. But you can save even more when you get the right care
– at the right place – based on your needs.
6
Where Should You Go for Care?
Most of the time, your primary doctor is the best place to get non-emergency care
for things like migraines, urinary tract infections, colds or the flu.
But when you can’t get a fast appointment, or you need care for non-emergency problems
after hours, PhysicianNow ® Powered by MDLIVE, Nurseline, urgent care and convenient care
centers are better choices than the emergency room. They’re open late and on weekends,
just like the ER, but you’ll usually get care faster and pay less.
Here’s how to find one in your network.
• Go to bcbst.com/Bridgestone and log in.
• Click Find Care & Estimate Costs.
How Much Will COST ESTIMATE
Your Care Cost? For Knee Replacement
Your
estimated cost
You can better plan for your share $4,973
of health care costs when you get
an estimate first. Our HealthCare
Cost Estimator tool lets you see
cost estimates* for more than Total Cost
1,400 common procedures. $25,175
You can even use it to compare
different doctors and facilities,
and see how other members Your insurer’s
rated them. estimated cost
$20,202
• Go to bcbst.com/Bridgestone and log in.
• Click on Find Care & Estimate Costs.
7
One-on-One Help
When You Need It
Feeling good and staying healthy aren’t always easy.
Sometimes, you need a hand from someone who understands
what you’re going through and can connect you to the right care.
8When You Have When You Have a
Extra Care Needs Long-term Health Problem
We can offer you extra support Some health problems are chronic or
and advice to get and stay healthy. long-term – that means you might need
Our priority is to make sure you get help making big changes or managing
the right care in the right place at a lot of needs. You can work with a
the right time. nurse or care manager for extra help
if you have one or more of these
We can help you: health problems:
• Find tools and community • Asthma
resources to support you.
• Chronic Obstructive
• Create a plan to take care of your Pulmonary Disease (COPD)
health using your doctor’s advice.
• Congestive Heart Failure
• Learn tips for taking your medicine
• Coronary Artery Disease (CAD)
the right way, eating healthy
and exercising. • Diabetes
9When You Need When You’re Pregnant
Mental Health Support
Having a healthy pregnancy takes some
work, but we’ve got you covered with our
Not all health problems are
Healthy MaternitySM program. From the start
physical. When you’re living
of your pregnancy until after your
with a mental health illness
baby is born, you can get:
or problem, you don’t have to
manage it all alone. • One-on-one advice from a maternity nurse
Our behavioral health team • Help understanding and using your
can connect you with: maternity benefits
• Online education and resources about
• Counseling and
having a healthy pregnancy and delivery
treatment programs
• Support for taking care of your newborn
• Community Resources
and yourself after delivery
• Inpatient or outpatient care
Call us at 1-800-818-8581 to learn more about these programs and how to enroll.
10Free Advice from a
Registered Nurse
Because illnesses, injuries and health
questions come up at all hours of the
day and night, our registered nurses
Nurseline and NurseChat are here for
are available anytime you need them.
you 24 hours a day, seven days a week.
With this free service, we can help
you make the best choices for you Online: visit bcbst.com/Bridgestone
and your family. This might be a and log in.
good choice for you if:
Phone: 1-800-250-7331 (Option 9)
• You want to ask general health
questions. TTY: 1-800-848-0298
• You’re not sure if you need to go
to the ER.
• You want to talk about
non-emergency symptoms and
your doctor’s office is closed.
Talk to Doctors Anytime
You Need Them
PhysicianNow ® Powered by MDLIVE lets
you connect with a doctor 24/7 by phone
or video chat. And you’ll typically pay less
You can talk with a doctor by phone
than you would for a visit to the office or
or video chat. It’s easy to get started.
urgent care clinic. Use PhysicianNow for
non-emergency conditions like: Register by logging in at bcbst.com/
PhysicianNow and clicking Talk With
• Allergies, cold, fever and flu
a Doctor Now. Or call 1-800-283-6691
• Sinus or respiratory issues
• Skin conditions (rashes or bug bites)
• Constipation, diarrhea, nausea
and vomiting
• Urinary tract infections, pink eye
and other infections
• Certain pediatric conditions
11Member Discounts to Help You
Live Better for Less
Living better shouldn’t cost you more. That’s why we’ve got you
covered with discounts on health and fitness services, programs and
gear to help you fit more healthy choices into your budget.
12Your health plan does more than just pay your
medical bills. Our Blue365® discount program
helps you save on everyday health-related Signing up is easy:
purchases like eyewear, nutrition programs and
fitness gear. We add new discounts all the time, • Log in to bcbst.com.
so check back often. Or sign up for email alerts
• Choose Managing Your
that let you know whenever we add something.
Health, then find the
Fitness Your WayTM lets you work out at more Fitness Your Way tile.
than 10,000 fitness centers across the country. • Or call 1-888-242-2060
Or you can work out from the comfort and safety Monday through Friday,
of home with recorded and live virtual fitness 9 a.m. to 6 p.m. ET
classes. You’ll pay a one-time $29 enrollment fee,
then $29 a month. You don’t have to sign a long
commitment — just three months to start.
* Participating facilities vary.
Find out more by logging in to bcbst.com,
choosing Managing Your Health and selecting
Member Discounts & Fitness Your Way.
13Know Your Rights
As a BlueCross BlueShield of Tennessee member, you have Our program is nationally recognized by two external
a number of rights, responsibilities and expectations that accrediting bodies, URAC and the National Committee
will engage you as a health care consumer and help you for Quality Assurance (NCQA). For more details about our
receive the type of care you deserve. More information Quality Improvement Program, please send requests to:
about your rights and responsibilities is available online at: BlueCross BlueShield of Tennessee
bcbst.com/manage-my-plan/member-rights.page. Attn: Quality Management 2.3
1 Cameron Hill Circle
Reviews of Medical Necessity Decisions Chattanooga, TN 37402
As a BlueCross BlueShield of Tennessee member, you
have the right to request a review by an independent third Your Benefits Under the Women’s Health
party of medical necessity decisions. You can learn more and Cancer Rights Act
about how your specific benefit plan handles requests for
independent reviews in your benefit materials or Evidence Your BlueCross BlueShield of Tennessee health plan, as
of Coverage (EOC). required by the Women’s Health and Cancer Rights Act of
1998, provides benefits for mastectomy-related services
Be Assured of Fair Decisions About Care including reconstruction and surgery to achieve symmetry
between the breasts, prostheses and the complications
BlueCross BlueShield of Tennessee works hard to earn resulting from a mastectomy (including lymphedema).
and keep your trust. Whenever possible, we want Please review your benefit plan materials for more details
to be open about how we make decisions. For prior about these benefits and your coverage in general.
authorizations and other health care decisions, we look
at two factors: whether the care or service suggested Notice of Information Privacy Policies
is appropriate for your condition and whether your plan
and Practices
covers it. BlueCross doesn’t reward employees, vendors
or contracted practitioners in any way for denying care, BlueCross BlueShield of Tennessee, Inc. and some
service or coverage. subsidiaries and affiliates are required to: Maintain the
privacy of all health plan information, which may include
Member Appeals Procedure your name, address, diagnosis codes, etc. as required
by applicable laws and regulations; provide this notice
Our appeal procedure, also called a grievance, procedure
of privacy practices to all members; inform members of
is intended to provide a fair and quick method of resolving
the company’s legal obligations; and advise members of
any disputes you may have with BlueCross BlueShield of
additional rights concerning their health plan information.
Tennessee. If you have a question about a claim, think a
Your health plan information may be used and disclosed for
claim has not been paid correctly, want to appeal a claim
treatment, payment, and health care operations. A copy of
decision or if you’re not happy with any aspect of your
this notice is included in your EOC. You may also request
BlueCross coverage, please contact our Member Service
a copy of our privacy practices at any time. Please contact
Department at 1-800-565-9140 (or the phone number on
BlueCross at:
your Member ID card). Please see your EOC for complete
information about the Member Grievance Procedure. • Phone: 1-888-455-3824
• Email: Privacy_Office@bcbst.com
Improving Your Quality of Care • Mail: BlueCross BlueShield of Tennessee
and Services The Privacy Office
1 Cameron Hill Circle
Your safety, quality of care and the services you receive
Chattanooga, TN 37402-0001
as a BlueCross BlueShield of Tennessee member are
important to you – and to us. That’s why we have a Quality
Improvement Program that is evaluated each year for
quality of care and service, appropriateness of care and
access to providers.
14HIPAA Compliant Ancillary Claims Process
BlueCross BlueShield of Tennessee, Inc. is compliant with Please ask your doctor to use in-network providers for
all requirements of the Health Insurance Portability and the following ancillary services to get the most out of
Accountability Act (HIPAA) of 1996. your benefits.
Independent Clinical Laboratories: Sometimes physicians
Insurance Terms will send your specimens drawn in their office to an outside
The online glossary at bcbst.com/manage-my-plan/ independent clinical laboratory for processing, which may
glossary-terms.page can help you better understand or may not be in the same state. To receive in-network
insurance terms such as “Effective Date” and “Maximum benefits for the lab work, the lab must be contracted
Allowable Charge.” To understand the meaning of a term, with the BlueCross plan in the state where your sample
you can check there for an easy-to-read description. was drawn.
The online Medical Policy Manual gives you easy-to Durable Medical Equipment (DME) (hospital beds, crutches,
find information to help you understand new medical wheelchairs, oxygen tanks, etc.): If you or your doctor
technologies and whether they’re appropriate for your orders DME or supplies, the DME company must be in the
particular situation. The manual’s medical policies identify network of the BlueCross Plan in that state to which the
technologies as medically necessary, not medically items are shipped in order to receive in-network benefits.
necessary, investigational or cosmetic. By researching If you purchase DME items from a retail store, the store
technology in advance, you can use your health care dollars must be in the network of the local BlueCross Plan.
more wisely. Specialty pharmacy (injectable or infusion drugs that your
Making sure you get the care and service you deserve is physician administers): If your doctor orders specialty
important to us. We work hard to make sure you’re happy pharmacy items for you, the specialty pharmacy company
with your health plan, so if there’s any reason you’re not, must be in the network.
please tell us. We’ll do everything we can if you have a
complaint about: Identity Protection
• The quality of your care Your benefits include Experian credit monitoring at no extra
• Availability of care cost. See the plans available and sign up by logging in to
• Your relationship with your providers, or with us your bcbst.com account.
• Anything else related to your health plan If you’re not
happy with any part of your care or your health plan, we
want to hear from you. Just give us a call at the number
on the back of your Member ID card.
If you’d rather write to us, please send it to us at:
BlueCross BlueShield of Tennessee
Commercial Member Complaint Department
1 Cameron Hill Circle, Suite 0019
Chattanooga, TN 37402-0019
15Multi-language Interpreter Services
BlueCross BlueShield of Tennessee (BlueCross) complies ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia
with applicable Federal civil rights laws and does not lingüística. Llame al 1-800-250-7331 (TTY: 1-800-848-0298).
discriminate on the basis of race, color, national origin,
age, disability or sex. BlueCross does not exclude people )رﻗﻢ800-250-7331-1 اﺗﺼﻞ ﺑﺮﻗﻢ. ﻓﺈن ﺧﺪﻣﺎت اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ ﺗﺘﻮاﻓﺮ ﻟﻚ ﺑﺎﻟﻤﺠﺎن، إذا ﻛﻨﺖ ﺗﺘﺤﺪث اذﻛﺮ اﻟﻠﻐﺔ:ﻣﻠﺤﻮظﺔ
or treat them differently because of race, color, national .(800-848-0298-1 :ھﺎﺗﻒ اﻟﺼﻢ واﻟﺒﻜﻢ
origin, age, disability or sex.
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電
BlueCross: 1-800-250-7331 (TTY:1-800-848-0298) 。
• Provides free aids and services to people with disabilities
to communicate effectively with us, such as: (1) qualified CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho
interpreters and (2) written information in other formats, bạn. Gọi số 1-800-250-7331 (TTY:1-800-848-0298).
such as large print, audio and accessible electronic 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
formats. 1-800-250-7331 (TTY: 1-800-848-0298) 번으로 전화해 주십시오.
• Provides free language services to people whose
primary language is not English, such as: (1) qualified ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont
interpreters and (2) written information in other proposés gratuitement. Appelez le 1-800-250-7331 (ATS : 1-800-848-0298).
languages.
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ,ການບໍລິການຊ່ວຍເຫຼືອດ້
If you need these services, contact a consumer advisor ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-250-7331
at the number on the back of your Member ID card or call (TTY: 1-800-848-0298).
1-800-250-7331 (TTY: 1-800-848-0298 or 711).
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው
If you believe that BlueCross has failed to provide ቁጥር ይደውሉ 1-800-250-7331 (መስማት ለተሳናቸው: 1-800-848-0298).
these services or discriminated in another way on
the basis of race, color, national origin, age, disability ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche
or sex, you can file a grievance (“Nondiscrimination Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-250-7331
Grievance”). For help with preparing and submitting your (TTY: 1-800-848-0298).
Nondiscrimination Grievance, contact a consumer advisor
at the number on the back of your Member ID card or સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો
call 1-800-250-7331 (TTY: 1-800-848-0298 or 711). 1-800-250-7331 (TTY:1-800-848-0298)
They can provide you with the appropriate form to use in
submitting a Nondiscrimination Grievance. You can file 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。
a Nondiscrimination Grievance in person or by mail, fax 1-800-250-7331 (TTY:1-800-848-0298) まで、お電話にてご連絡ください。
or email. Address your Nondiscrimination Grievance to:
Nondiscrimination Compliance Coordinator; c/o Manager, PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo
Operations, Member Benefits Administration; 1 Cameron ng tulong sa wika nang walang bayad. Tumawag sa 1-800-250-7331
Hill Circle, Suite 0019, Chattanooga, TN 37402-0019; (TTY:1-800-848-0298).
(423) 591-9208 (fax); Nondiscrimination_OfficeGM@
bcbst.com (email). ध्यान दें: यिद आप िहंदी बोलते हैं तो आपके िलए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।
1-800-250-7331 (TTY:1-800-848-0298) पर कॉल करें।
You can also file a civil rights complaint with the U.S.
Department of Health and Human Services, Office for ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные
Civil Rights, electronically through the Office for Civil услуги перевода. Звоните 1-800-250-7331 (телетайп: 1-800-848-0298).
Rights Complaint Portal, available at https://ocrportal.
hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: با. تسهیالت زبانی بصورت رایگان برای شما فراهم می باشد، اگر به زبان فارسی گفتگو می کنید:توجه-
U.S. Department of Health and Human Services, . تماس بگیرید. 1-800-250-7331 (TTY:1-800-848-0298)
200 Independence Avenue SW., Room 509F, HHH
Building, Washington, DC 20201, 1-800-368-1019, ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou
800-537-7697 (TDD). Complaint forms are available at ou. Rele 1-800-250-7331 (TTY: 1-800-848-0298).
http://www.hhs.gov/ocr/office/file/index.html. UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy
BlueCross BlueShield of Tennessee, Inc., an Independent językowej. Zadzwoń pod numer 1-800-250-7331 (TTY: 1-800-848-0298).
Licensee of the BlueCross BlueShield Association.
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis.
The PhysicianNow program operates subject to state Ligue para 1-800-250-7331 (TTY: 1-800-848-0298).
regulation and may not be available in certain states.
PhysicianNow phone consultations are available ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di
24/7 while video consultations are available during assistenza linguistica gratuiti. Chiamare il numero 1-800-250-7331
the hours of 7 a.m. to 9 p.m. seven days a week or (TTY: 1-800-848-0298).
by scheduled availability. MDLive is an independent
internet-based service that allows consumers to select D77 baa ak0 n7n7zin: D77 saad bee y1n7[ti’go Diné Bizaad, saad bee
and interact with independent physicians and other 1k1’1n7da’1wo’d66’, t’11 jiik’eh, 47 n1 h0l=, koj8’ h0d77lnih 1-800-250-7331
health care providers. For complete terms of use, visit (TTY: 1-800-848-0298).
welcome.mdlive.com/terms-of-use.
Tivity Health and Fitness Your Way are registered
trademarks or trademarks of Tivity Health, Inc., and/
or its subsidiaries and/or affiliates in the USA and/or
other countries.
© 2018 Tivity Health, Inc. All rights reserved.QUICK REFERENCE TO BLUECROSS RESOURCES
Answers to Your Questions Online or on the Phone
1-800-250-7331 bcbst.com/Bridgestone
24/7
Where You Can Find It Online
Benefit Subject bcbst.com myBlue TN
Plan Benefits
Family Members Covered Benefits & Coverage My Insurance
Amount of Copays and Deductibles
Claims (archived for two years)
Deductible Balances Claims & Balances My Insurance
Out-of-Pocket Maximum
Talk to a Nurse*
Managing Your Health Main Menu
Talk to a Doctor
Find a Doctor (Network, Specialty or Location)
Find Care Main Menu
Locate an Urgent Care Center
Blue365 Discount Program
Managing Your Health
Fitness Your Way
Explanation of Benefits (EOB)
Claims & Balances
Personal Health Statement
Member Service in
Create a Personal Health Profile Other Languages:
1-800-250-7331
Take a Personal Health Assessment Managing Your Health
Self-Directed Online Coaching*
Compare Doctors by Cost and Quality
Find Care
Read Doctor Reviews from Members
* Service may not apply to all plans.
1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.com
COMM-699-BSTN_20SAM1004119 (12/20)You can also read
